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- Austeng, Dordi, et al.
(författare)
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Incidence of and risk factors for neonatal morbidity after active perinatal care : extremely preterm infants study in Sweden (EXPRESS)
- 2010
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 99:7, s. 978-992
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aim of this study was to determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods: Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004-2007. Results: Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long-term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotizing enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage >= 3. Eighty-five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty-seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusion: Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long-term health of survivors are warranted.
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| 2. |
- Lindqvist, P. G., et al.
(författare)
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Umbilical artery Doppler in relation to placental pathology and FV Leiden in pregnant women and their offspring
- 2013
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Ingår i: Journal of Maternal-Fetal & Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 26:14, s. 1394-1398
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Abnormal umbilical artery blood flow has been implicated in pregnancy complications and fetal demise. Its relation to histopathological changes in the placenta and to maternal or fetal thrombophilia is less well understood. The aim of this study was to evaluate the relation between umbilical artery Doppler findings, placental histopathology, and maternal and fetal coagulation factor V Leiden (FVL) status. Methods: Two previous studies on FVL in pregnancy made the placentas of 25 women with maternal FVL carriership and 43 randomly selected non-carriers available for a histopathological examination. Umbilical artery Doppler velocimetry was performed on 54 women in late pregnancy. Results: Abnormal umbilical artery Doppler velocimetry was associated with an approximately sevenfold increased risk of fetoplacental thrombotic vasculopathy (odds ratio [OR]: 7.5, 95% confidence intervals [CI]: 1.3-44.3), ischemic lesions (OR: 7.5, 95% CI: 1.2-46.1) and fetal carriership of FVL (OR: 8.2, 95% CI: 1.5-43.5), but not maternal FVL. Fetal FVL carriership was also associated with a sevenfold increased risk of ischemic lesions (OR: 6.7, 95% CI: 1.3-35). Conclusions: Our results indicate that the fetal - not the maternal - FVL carriership matters regarding the umbilical artery blood flow and placental pathology, which might explain some of the heterogeneity of studies.
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| 3. |
- Thuring, Ann, et al.
(författare)
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Placental ischemia and changes in umbilical and uteroplacental arterial and venous hemodynamics.
- 2012
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Ingår i: Journal of Maternal-Fetal & Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 25, s. 750-755
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To relate Doppler velocimetry findings in fetoplacental and uteroplacental circulation to placental histomorphology. Material and methods: In 14 uncomplicated and 31 high-risk pregnancies Doppler velocimetry was performed in umbilical artery and vein, and in maternal uterine veins and arteries during the second half of gestation. Histopathology of the placentas was examined, especially for signs of ischemia and inflammation. Results: All fetuses in uncomplicated pregnancies had normal flow velocity waveforms in umbilical artery; in the high-risk group, 18 fetuses had abnormal flow (increased PI or absent/reverse end-diastolic flow). The latter group had more often high ischemic score and infarctions in the placenta than found in pregnancies with normal umbilical artery flow (p < 0.001 and p = 0.02, respectively). Similarly, the abnormal uterine artery flow pattern (uterine artery score 3-4) occurred more often with high ischemic score and placenta infarctions (p < 0.001 and p < 0.001, respectively). No significant associations were found between the uterine venous flow type and placental ischemia. Conclusion: Placental ischemic morphological changes were associated with Doppler ultrasound signs of increased resistance to arterial blood flow, both on the fetal and maternal sides of the placenta. No significant relation to the uterine venous flow velocities was found.
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| 4. |
- Thuring, Ann, et al.
(författare)
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Uterine venous blood flow in normal and complicated pregnancies: a methodological study.
- 2010
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Ingår i: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. - : Wiley. - 1469-0705. ; 35, s. 462-467
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE.: Finding of venous congestion at histopathological examination of placenta indicates the importance of abnormal placenta-maternal venous return. The present descriptive study investigates the possibility of recording Doppler flow signals from maternal uterine veins. MATERIAL AND METHODS.: Transabdominal Doppler ultrasound examinations of uterine veins on both sides of uterus were performed. The uterine vein (UtV) was identified using colour Doppler and the flow velocity signals of UtV and uterine artery (UtA) were recorded. 40 normal and 44 high-risk singleton pregnancies were examined at 23 to 39 gestational weeks. Morphological examination of the placenta was carried out in 45 of pregnancies. RESULTS.: Flow velocity signals of the uterine veins were recorded from at least one side of the uterus in all patients (success rate 81 % and 89 % for the right and left UtV, respectively). Three types of flow velocity pattern were identified: continuous non-pulsatile flow (type I, n=70), pulsatile flow with a notch touching the zero line (type II, n=6), and pulsatile flow with absent flow signals for a part of the heart cycle (type III. n=8).The UtA pulsatility index was significantly higher in women with UtV types II and III than in those with UtV type I (p=0.039). Similarly, the UtV types II and III were more often found in pregnancies with bilateral UtA notch (p=0.013) and with uterine artery score (UAS) 3-4 (p=0.024) than in cases with normal UtA. No statistical significant association was found between the UtV flow pattern and abnormal histopathological findings in placenta, and between the UtV and umbilical artery findings. CONCLUSION.: It is possible to record Doppler signals from the uterine veins in the second and third trimester pregnancies. The abnormal flow velocity patterns of the uterine veins were associated with abnormal Doppler findings in the uterine artery. Copyright (c) 2010 ISUOG. Published by John Wiley & Sons, Ltd.
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